Provider Demographics
NPI:1790427102
Name:EALEY, DIANE (ALC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:EALEY
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEADLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36345-1854
Mailing Address - Country:US
Mailing Address - Phone:334-794-2113
Mailing Address - Fax:334-785-2522
Practice Address - Street 1:894 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HEADLAND
Practice Address - State:AL
Practice Address - Zip Code:36345-1854
Practice Address - Country:US
Practice Address - Phone:334-794-2113
Practice Address - Fax:334-785-2522
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health